On March 28, 2025, a 7.7-magnitude earthquake struck central Myanmar (GLIDE #EQ-2025-000043-MMR), compounding the country’s existing political instability, economic fragility, and infrastructural weaknesses. Although seismic events have recurred throughout history, limited knowledge exists regarding how working-age adults (18-60), who play a central role in recovery, mobilize personal, cultural, and community resources to cope with adversity and reconstruct their lives. This is a protocol clarification for a remote access qualitative study using semi-structured interviews with 30 purposively sampled participants, half from heavily impacted zones (Sagaing, Mandalay) and half from nearby regions experiencing secondary disruption (Yangon). Using a remote system, interviews will be audio-recorded, transcribed verbatim, and analyzed thematically following Graneheim and Lundman’s approach. This study aims to identify key coping strategies, including social support networks, spiritual practices, and local initiatives of working-age adults in Myanmar, and to compare how exposure severity shapes adaptive responses. Anticipated themes based on existing disaster and resilience literature include community-led resilience, hope through faith, and resource-sharing practices. Findings are expected to offer in-depth, culturally grounded insights that can inform disaster recovery programs, psychosocial support services, and policy frameworks aimed at strengthening resilience in Myanmar and similar low-resource, low-accessibility, crisis-affected settings.

The doctor shortage is a general healthcare problem on many remote islands, which differ geographically from the mainland. Revealing the factors for recruitment and retention of doctors on remote islands may help develop countermeasures. We systematically investigated the factors related to recruitment and retention of doctors specifically on remote islands. The literature available from PubMed, CENTRAL, and Embase up to May 2024 was reviewed. Eligible studies were original articles with cohort, case-control, cross-sectional, and interventional designs that focused on recruitment and retention of doctors on remote islands. For this study, the “island” was defined as an area and region surrounded by water and separated from the “mainland”. The risk of bias was evaluated using the Newcastle-Ottawa Quality Rating Scale. We identified nine eligible original articles, including six cohort studies and three cross-sectional studies on recruitment and retention of doctors reported in Hawaii, Tasmania, and Maluku. In four studies on recruitment, the identified factors were island background, medical education on islands, and quality of life on islands. In six studies on retention, the identified factors were island background, medical education on islands, quality of life on islands, opportunities for professional training, family-related factors, working conditions, and financial incentives. These findings would be useful for policymakers and healthcare planners to secure doctors on remote islands. Further studies are warranted.

This study aims to investigate the predictive value of long non-coding RNA taurine-upregulated gene 1 (lncRNA TUG1) for complications following cesarean section in patients with scarred uterus. We first included 186 subjects with scarred uterus. The levels of TUG1 in the serum of these subjects were measured using RT-qPCR, and based on the expression levels of TUG1, they were divided into TUG1 high expression group (90 cases) and TUG1 low expression group (96 cases). The postpartum hemorrhage, postoperative site infections, pelvic floor muscle strength, and vaginal microbiota status were compared between the two groups. And the predictive value of TUG1 for complications following cesarean section in women with scarred uteri was assessed using the receiver operating characteristic (ROC) curve. The levels of TUG1 were found to be strongly positively correlated with the abdominal scar score of the pregnant women. Furthermore, TUG1 levels in women who experienced pelvic floor dysfunction (PFD), vaginal microbiome disorders, surgical site infections (SSI), and postpartum hemorrhage were significantly higher than those in women without these complications. The ROC curve indicated that TUG1 predicted PFD, vaginal microbiota disorders, SSI, and postpartum hemorrhage with areas under the curve (AUC) of 0.811, 0.832, 0.819, and 0.887, respectively. TUG1 was positively correlated with abdominal scar scores and demonstrated good predictive value for complications after cesarean section in women with scarred uteri. These findings suggest that TUG1 has the potential to serve as a clinical biomarker for these complications.

Coronary atherosclerosis (CAS) is a frequent clinical disease that critically affects human health and requires an early diagnostic marker. MicroRNAs (miRNAs) have the potential to be diagnostic markers due to their aberrant expression in a wide range of diseases. In this study, the levels of miR-411-5p and vasodilator-stimulated phosphoprotein (VASP) were analyzed by qRT-PCR. ROC curves were analyzed for the diagnostic value of miR-411-5p. Human Umbilical Vein Endothelial Cells (HUVECs) were treated with ox-LDL to construct a cell model. Cell proliferation, apoptosis, and inflammatory factors levels were evaluated by the CCK-8, flow cytometry, and Enzyme-linked immunosorbent assay (ELISA). The levels of miR-411-5p were higher in CAS patients than in controls. Ox-LDL promoted the miR-411-5p levels and suppressed VASP in cells. Suppressing miR-411-5p markedly mitigated ox-LDL suppressive effect on cell proliferation while also diminishing its stimulatory roles in apoptosis and inflammation. However, this alleviation was notably reversed when VASP expression was diminished. MiR-411-5p holds promising prospects as a diagnostic marker for CAS, and targeting the miR-411-5p/VASP axis could mitigate the progression of CAS.

The prevalence of type 1 (T1D) and type 2 (T2D) diabetes in reproductive women is rising. Subclinical hyperglycemia’s impact on adverse pregnancy outcomes is evident. Nevertheless, the variance in outcomes between T1D and T2D pregnancies is not well-defined. We retrospectively analyzed 68 pregnancies (28 T1D, 40 T2D) at the Gunma University Hospital (Dec 2017-Mar 2022), examining maternal characteristics, insulin therapy, prepregnancy body mass index (BMI), glycated hemoglobin (HbA1c) levels, daily insulin dose, gestational weight gain, and perinatal outcomes. In T1D pregnancies, those with large-for-gestational age (LGA) infants had less improvement in HbA1c early in pregnancy and greater weight gain overall. Notably, even non-obese women with T1D often gained excessive weight, which was closely tied to LGA risk. The risk increased sharply when third-trimester HbA1c exceeded 48 mmol/mol (6.5%). These findings suggest that, despite significant gestational weight gain, insulin doses may not have been sufficiently escalated to match increased insulin resistance, contributing to both poor glycemic control and a higher risk of LGA in T1D pregnancies. Our study underscores the importance of tailoring insulin therapy and weight management to reduce LGA risk in T1D. As the use of advanced technologies such as continuous glucose monitoring (CGM), continuous subcutaneous insulin infusion (CSII), and sensor-augmented pump (SAP) therapy continues to expand in pregnancy care, ongoing data updates will be essential to refine clinical strategies and improve maternal and neonatal outcomes.

This study sought to delineate the effects of calcitriol (CAL) and clarify its role in modulating TGF-β1/SMAD-mediated myocardial fibrosis in both animal and cellular models, instigated by isoproterenol (ISO). Cardiac dysfunction was precipitated through the subcutaneous administration of ISO in BALB/c mice, followed by an assessment of the remedial effects of CAL. CAL intervention ameliorated cardiac fibrosis induced by excessive ISO exposure, which was underscored by the reduction in myocardial hypertrophy and levels of interstitial fibrosis in the cardiac tissue. ISO exposure triggered the TGF-β1/SMAD pathway and suppressed vitamin D receptor (VDR) expression; effects that were nullified by CAL therapy. Cardiac fibroblasts (CFs) were extracted from myocardial ventricles of mice, and CCK-8 assays were conducted to evaluate the viability of CFs under treatments with ISO, sTβRII (a TGF-β1 inhibitor), and CAL. The CF survival rate was increased by ISO treatment, although this was counteracted via sTβRII or CAL treatment. In this cell model, ISO treatment activated TGF-β1/SMAD pathway and downregulated VDR expression, whereas CAL cotreatment exerted a converse effect on the TGF-β1/SMAD pathway and VDR expression. VDR knockdown demonstrated its role in CAL-mediated alleviation of cell fibrosis. Our observations indicated that VDR intervention enhanced the influence of ISO on the proliferation of CFs and markedly negated the protective effects of CAL on the viability of ISO-exposed CFs. These insights unveil a pioneering role for CAL in curbing ISO-provoked cardiac fibrosis and the proliferation of CFs via the restraint of the TGF-β1/SMAD pathway through engagement with the VDR.

A 69-year-old female was admitted to our hospital due to muscle weakness and gait disturbance. She noted weight loss attributed to inadequate dietary intake and alcohol use approximately 4 months prior. The laboratory findings were as follows: K 2.9 mEq/L, Ca 3.7 mg/dL, Alb 2.4 mg/dL and creatine kinase (CK) 3,986 U/L. Muscle magnetic resonance imaging (MRI) demonstrated abnormal signals in the proximal lower limb muscles. Hypokalemia-induced rhabdomyolysis was suspected. However, her hypokalemia was initially refractory to potassium replacement. Further examination revealed hypomagnesemia (Mg 1.6 mg/dL), and thus oral magnesium supplementation was given alongside potassium. Afterward, the patient’s clinical symptoms and electrolyte disorders normalized within10 days; her muscle weakness and myalgia with elevated levels of CK also resolved. Thus, the hypokalemia-induced rhabdomyolysis in this patient was attributed to the coexisting magnesium deficiency. Electrolyte abnormalities and trace element deficiencies can be complicated by states of malnutrition. Awareness of hypomagnesemia may be of crucial importance for the management of hypokalemia-induced rhabdomyolysis. This case report suggests that hypomagnesemia can worsen hypokalemia-induced rhabdomyolysis in patients with impaired nutritional status. Therefore, careful monitoring of electrolytes is required in patients with unusual rhabdomyolysis.

This study explores the regulatory effects of Heat Shock Protein A1B (HSPA1B) on gene expression related to blood pressure in Human Umbilical Vein Endothelial Cells (HUVECs) and delineates its underlying mechanisms. Given the global prevalence of hypertension as a major risk factor for cardiovascular and cerebrovascular diseases, understanding its molecular underpinnings is crucial. We utilized cloning, cell culture, RNA isolation, cDNA synthesis, PCR amplification, high-throughput sequencing, and alternative splicing analysis to evaluate the impact of HSPA1B overexpression on HUVECs. The findings revealed that HSPA1B overexpression leads to significant changes in gene expression and alternative splicing patterns, implicating various molecular pathways. Notably, genes associated with inflammation, immune response, apoptosis, and endothelial function were upregulated, while others were downregulated. These alterations suggest that HSPA1B may influence endothelial cell responses under stress conditions. This study provides insights into the molecular mechanisms that could contribute to hypertension development and identifies HSPA1B as a potential area for further research in therapeutic strategies to manage this condition.

Esophagectomy is a high-complexity procedure, and the relationship between hospital volume, measured by the annual number of esophageal surgeries per hospital, and treatment outcomes remains a subject of debate. This study used a nationwide administrative database to identify patients diagnosed with stage 2 and stage 3 esophageal cancer between April 1, 2016, and March 31, 2022. We focused on patients who underwent preoperative chemotherapy and thoracoscopic esophageal cancer surgery and examined the relationship between hospital volume, in-hospital mortality, and postoperative complications. The hospitals were categorized into two groups: the low-volume group (n = 2,629) with less than 12 thoracoscopic esophagectomies performed annually and the high-volume group (n = 5,325) with 12 or more. We conducted propensity score matching analysis to match pairs of patients between the low-volume and high-volume groups (n = 1,984, each). In the analysis after matching, the in-hospital mortality rates were higher in the low-volume group compared to the high-volume group (1.4% vs. 0.5%, p = 0.0022). Furthermore, the incidence of postoperative complications was significantly higher in the low-volume group compared to the high-volume group: wound infections (1.7% vs. 0.7%, p = 0.0337), anastomotic leakage (6.5% vs. 2.8%, < 0.0001), and recurrent laryngeal nerve paralysis (8.3% vs. 6.5%, p = 0.0291). However, the incidence of postoperative pneumonia was higher in the high-volume group (1.7% vs. 3.5%, p = 0.0003). The length of postoperative hospital stay was also significantly longer in the low-volume group compared to the high-volume group (24 days, IQR: 18-35 vs. 20 days, IQR: 16-28, p < 0.0001). Further analysis considering the patient’s quality of life, access to hospitals, and careful discussion is necessary to determine the appropriateness of esophagectomy centralization.

Mobile radiography is useful for triaging patients during disasters. However, in the face of large-scale disasters, medical equipment, including X-ray systems, may be restricted because of power outages. Therefore, a novel mobile radiography system that can be used in any disaster was developed, and its basic performance was evaluated. This system is designed for use during power outages and can be recharged using both household and solar power sources. The reproducibility of the X-ray output of the system (irradiation dose, tube voltage, radiation quality and irradiation time) was excellent, confirming that radiography could be performed consistently. The entrance surface dose and scattered radiation during chest radiography were measured using a chest phantom. Both results were acceptable, verifying that the system is sufficiently safe from the viewpoint of radiation protection. This novel mobile radiology system is easy to carry and can generate solar power, making it useful during a power outage in the case of a large-scale disaster or when examinations need to be performed outside a hospital, such as at a first-aid station.

Reprogramming of glucose metabolism is a hallmark of hepatocellular carcinoma (HCC); however, the intrinsic mechanisms underlying this phenomenon remain unclear. The present study aimed to investigate the role and potential mechanism of glycyl-tRNA synthetase (GARS) in HCC glycolysis. Our results revealed an increase in the expression of Kruppel-like factor 16 (KLF16) and forkhead box K1 (FOXK1) in HCC tissues and correlated with an unfavorable prognosis. Mechanistically, we demonstrated that KLF16 binds to the promoter region of GARS, thereby enhancing its transcription. Subsequently, the GARS protein then binds to FOXK1, resulting in reduced ubiquitination and increased stability of FOXK1. FOXK1 then promotes glycolysis by directly stimulating the transcription of lactate dehydrogenase A, pyruvate kinase M2 and glucose transporter 1 in HCC cells. Additionally, KLF16 knockdown inhibited glycolysis in HCCLM3 cells both in vitro and in vivo. Collectively, these findings indicate that the KLF16-GARS-FOXK1 axis plays a critical role in regulating HCC growth and glycolysis. Targeting this pathway may hold a promising therapeutic strategy for HCC treatment.

The infection of Enterovirus A 71 (EV-A71) could cause severe hand-foot-mouth disease (HFMD), which poses a grave threat to the lives of children. Moreover, in some cases where the children survive, long-term neurological sequelae may occur. Acupuncture can alleviate cognitive dysfunction, however, its role in HFMD has not been investigated. HFMD models caused by EV-A71 infection were constructed in Sprague–Dawley infant rats. Morris water maze test was employed to evaluate the spatial learning and memory function administered by the interventions of SB203580 or/and acupuncture. The changes and apoptosis degree of hippocampus tissues were evaluated by H&E staining and TUNEL staining assay. Furthermore, the western blot was utilized to detect the apoptosis-related proteins as well as the proteins involved in the p38 MAPK/CREB pathway within the tissues. After induction with EV-A71, compared to the control group, the rat’s escape latency increased noticeably, while the time duration spent on the platform and the number of platform-crossing times decreased significantly. Moreover, in the hippocampal tissues of EV-A71-infected rats, pyramidal cells were loosely arranged, of different sizes and disorganized, as well as the numbers of neuronal cell apoptosis were significantly elevated, accompanied by increased expression of phosphorylated p38 and down-regulations of phosphorylated CREB. Interestingly, these effects could be relieved by acupuncture or SB203580 intervention, and acupuncture could additionally enhance the influence of SB203580. Acupuncture might modulate the p38 MAPK/CREB pathway, thus alleviating the impairment of spatial learning and memory, as well as the apoptosis in the hippocampus of rats infected with EV-A71.